POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: GaryUK on December 10, 2006, 02:23:15 am
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:'(
Dear Forum
I’m extremely worried about a situation which occurred a couple of hours ago. In a moment of sheer stupidity I had sex with a street prostitute. She seemed very friendly but had a very pale complexion, although I appreciate that’s not indicative of infection.
She asked if I had a condom, which I did, and this prompted her praise. She laughed but said it was good to be prepared. She started off with oral and then we proceeded with penetrative sex from behind. The whole incident lasted no more than about 10 minutes but when I removed myself from inside her, the condom had broken. I can’t be certain how long into the act this happened, but I’m assuming it was for the considerable duration of intercourse.
My heart instantly fell into my stomach when I noticed the split condom & naturally I looked immediately for her reaction, which was completely calm, like nothing had happened. I casually asked if she if the situation should be of concern to me, to which she became very angry and told me to ‘f*&k off’, before exiting the car park & running off down the road.
After she had gone I checked my penis for signs of blood, but there was nothing visible. But I did notice some dry skin around the tip of the foreskin which had cracked, but not bled.
Can someone please help me rationalise this situation and put my risk into perspective. I’m so terrified & for the last 2 hours have done nothing except panic and vomit.
Please help me. Thank you.
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You were mostly protected during the sexual incident. It is actually very hard to get HIV from a woman during penetrative sex. So, from this one-time incident you would be very unlikely to test positive for HIV. You might want to check other STDs though. I am not surprised she told you to F-off after you asked her that. You basically said, "Have you got HIV/STDs". How would you feel if someone said that to you? Same reaction, I imagine.
R
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HIV is not an easy virus to transmit. It's significantly more difficult to accomplish from female to male. You were protected until the condom broke. Given that it was a single incident the odds are overwhelmingly in your favor against transmission having occured even IF the woman was HIV+, and that's IF, since you don't know it to be so.
Getting tested is a good idea just to confirm your negative status. The CDC recommends doing that at 13 weeks. That may seem like a forever length of time to wait. You can test at 6 weeks since by that time all but the smallest number of those who are going to seroconvert will have done so. Assuming you get the negative result I expect, re-test at 13 weeks, collect another one and mark the matter "closed."
I expect you will come out of this ok.
Cheers,
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Andy, Hiv worker, thank you.
Naturally this whole situation has caused a significant degree of unrest. Approaching xmas intensifies the problem as you have to make more of an effort to be sociable & happy. It's going to be a difficult period, but obviously unavoidable. Hopefully it'll result with a negative result & a valuable lesson.
I'm making every effort to remain calm but occasionally the realisation of what may potentially manifest itself from this situation becomes overwhelming & terror engulfs my senses.
In an effort to help me understand the virus I purchased a book endorsed by Peter Piot, Executive Director of UNAIDS. I've only had time to briefly glance through some of the information but I have one or two questions perhaps yourselves, or another member of the forum could help me understand.
The book describes the infection process in-depth, and goes on to define the window period as an 'unseen war between virus & immune system'. It then suggests this process can last anywhere between 'Several weeks & several months', during which time antibodies to HIV are undetectable. The concluding content of this paragraph mentions a flu like illness which usually occurs after the window period, but is not immediately associated with infection.
Other information acquired from the book mentions that 'sufficient quantities' of the virus have to exist for transmission to take place & also the statistic probability of infection between 'Female to Male' transmission is 1-700 to 1-13,000.
A few questions have arose in my mind regarding certain elements of this information. If someone on the forum has time, and would be kind enough, perhaps they could help me clarify some misunderstandings I have.
Firstly, I was under the impression the window period was 13 weeks, but ARS generally occurs between 2 & 4 weeks. If the process leading up to the detectable stage of infection can last anywhere between 'Several weeks & Months', does that mean it's possible to test negative at 13 weeks, but seroconvert after this time frame?
Secondly, the book offers two percentages for Female to Male transmission. Could anyone explain the deviation between the two figures?
Thirdly, what is meant by sufficient quantities'. Does that mean the bodies natural defence mechanisms can effectively combat small amounts?
Any assistance on these matters would be greatly appreciated.
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Gary,
First, I've got a couple questions for you. One, what is the title of this book and two, what is the publication date. It sounds like outdated info to me. Piot has been Executive Director of UNAIDS since 1995 and our understanding of hiv transmission and infection has grown by leaps and bounds since then. It's like comparing the creation of the telegraph with the creation of mobile (cell) phones.
The discrepancy between the stats for transmission comes from the fact that they pull these numbers from thin air. There is no way on earth that we will ever have reliable stats on transmission.
Think about it. Many people don't know they are hiv positive. It stands to follow that many people (sexual partners of people who don't know their positive status) don't know they were exposed. Only the people who actually become infected find out - whether they test within six weeks, or they don't test for years following their exposure and infection.
So how could we possibly say that X amount of exposures result in Y amount of infections? The only number here that can come anywhere near being a known number is Y. There is no way to know how many real exposures happen every single day, but do not result in infection.
ARS and seroconversion are not the same thing. ARS stands for Acute Retroviral Syndrome. It's the term used to describe the illness that some - but not all - people experience while the body begins to attack the virus and produce antibodies.
Seroconversion refers to the point where the amount of antibodies present in the blood becomes enough to detect. Sero (blood) conversion (change)... blood change from hiv negative to hiv positive. Seroconversion.
The vast majority of people who have actually been infected will seroconvert and test positive by six weeks. We DO know this through years of people testing after a definite risk. We know this through the experiences of hundreds of thousands of hiv testing centers throughout the world.
Ann
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Secondly, the book offers two percentages for Female to Male transmission. Could anyone explain the deviation between the two figures?
Rates of transmission from female to male are lower in the context of a stable monogamical serodiscordant relationship, and are much higher in the context of casual sex with random partners. Rates of transmission from female to male are also lower when male circumcision is more prevalent in the population studied.
The main reason the average transmission probability per sexual act is underestimated in studies withe serodiscordant couples is that these studies exclude the most infectious individuals, which are the ones who would have recently seroconverted. These studies do not capture couples in which neither partner tests positive for HIV, but one recently has become infected. This a link that has some information of hiv transmission in the acute phase:
http://www.i-base.info/pub/htb/v5/htb5-6/Sexual.html
Also, some people are more susceptible than others to be infected, and when you select serodiscordant couples, it is likely that the very existence of the serodiscordance is a consequence of one of the partners being less susceptible to HIV infection, otherwise there would be no serodiscordance.
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ronaldinho, please keep all your thoughts and concerns in your own thread.
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Thank you Ann, and everyone else who's contributed.
Ann, to address your question the book is entitled 'AIDS in the Twenty-First Century' and was published in 2006. It's the Second Update Edition & recommend to students studying HIV. So that this information can be assessed correctly, I've emulated the text below word for word.
"This period is marked by an unseen and Unfelt war in the person's body. The viral load is high, the immune system is taking a knock, and the persons HIV status cannot be detected using standard tests. This is commonly called the 'Window period' and lasts from several weeks to several months. At this stage a person is highly infectious as his or her viral load is considerable.
An infected person will usually experience an episode of illness at the end of the window period- but this will often resemble flu and will not be seen as a marker for HIV."
I hope this adds some clarity to my previous comments, Ann. I appreciate the need to reference information, as validating the source is of primary importance.
I'm starting to feel more and more pressure as each day passes. I just hope the young lady wasn't HIV positive. It was just her desensitised calmness to the situation that concerns me.
Thank you everyone. Any additional information on my risk, & rapid testing would be comforting.
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I suggest you have to turn your efforts into a totally different direction. Of course you're concerned and anxious to know your HIV test result. And you have some waiting time to get through.
What you are expending your energy on right now is from my point of view not helpful. You want to nail it all down with assurance. The bottom line in this is what you have been told. The odds are very much in your favor that you will test negative. But, you have to wait to get tested.
I suggest you get productively busy with non-HIV searching. You will be amazed at how quickly the time can pass when you do that. Surely there must be other things in your life with which you can be fruitfully engaged. When your mind comes up with more questions and doubts, notice them, take a breath and let them go. Searching for those answers just brings up more questions.
Healthy activities including exercise would be a much better use of your energy. No kidding.
Cheers,
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Rates of transmission from female to male...
are much higher in the context of casual sex with random partners.
Ronald,
NO. I just explained in my previous post why we cannot know what you stated above. (please re-read my other post again) There is no reason to think that the rates of infection are any higher in the wildcard* population than in the known serostatus population.
*(I'm using "wildcard population" to denote casual sex couples were one person doesn't know they're positive and so the other person didn't know they were exposed and never tested. If they don't end up testing positive at some point down the line, we have no way of knowing they were exposed. This skews the over-all results as we only find out about people who were unknowingly exposed and then subsequently test positive.)
In the case of acute infection when the viral load is high, there is not reason to suspect that the transmission rate will be any higher in casual couples than in long-term couples. The rate of infection will naturally be high in either group. The virus doesn't know the state of your relationships.
The serodiscordant couple studies also included positive people who were NOT on meds, and so had a detectable viral load. The serodiscordant couple studies were well designed and have told us more about transmission and risks than any other studies to date.
Also, some people are more susceptible than others to be infected, and when you select serodiscordant couples, it is likely that the very existence of the serodiscordance is a consequence of one of the partners being less susceptible to HIV infection, otherwise there would be no serodiscordance.
It is my understanding that the studies also selected couples that had not been together for very long, in order to make sure the aspect you raise was also covered.
Ann
By the way Ronald, you seem to drop in now and again with comments, but we know nothing about you. It would be nice if you started a thread to fill us in - perhaps in Off Topic if you are not positive yourself, or in Living if you are. Thanks.
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Gary,
The only part of what you quote that I don't agree with is this:
An infected person will usually experience an episode of illness at the end of the window period- but this will often resemble flu and will not be seen as a marker for HIV."
If a person experiences an illness that is being caused by acute infection, it usually happens between two and four weeks into the window period, not at the end. The window period is the time from the actual exposure to three months after the incident occurred. In light of this, the article would be referring to an illness happening at three months.
At the very beginning of the illness, a person would be likely to still be testing negative. At some point during the illness, the test would likely come back as indeterminate, which means that some bands on the test showed positive while others did not. By the time the illness is over, most people will have moved on from indeterminate results to positive results. People who were still indeterminate at the end of the illness will test positive within a matter of days. IF they were actually infected and didn't have a false-indeterminate.
You HAVE to keep in mind that many people do not experience any illness at all. This is one of the reasons we refuse to concentrate on symptoms being indicative of infection. To do that would possibly lead people who experience nothing to assume they have nothing to worry about. This is one reason why so many people only find out years down the line when they are very sick. The assume they were never infected, despite real risks, because they never became ill. Thinking that symptoms equal hiv is very dangerous thinking indeed. I know far more positive people who say they never had an illness than positive people who had an obvious seroconversion illness (aka ARS).
I totally agree with Andy here. You need to keep yourself productively busy while you wait for your test. It is rare indeed for the insertive partner to become infected following a condom break. I've yet to see a single case of this happening and I don't expect you to be the first.
Ann
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Andy & Ann, thank you.
I apologise for any disruption or irritation I've caused you, or the forum. It was wrong of me to quote an external source, as I appreciate this may be counter productive to the emotional stability of other members facing similar feelings of terror.
Andy, you are 100%. I'm searching for answers that cannot possibly be attained without testing, but I'm sincerely grateful for the understanding & empathy you've all shown.
I guess it's only natural for the mind to generate unestablished fears, especially when dealing with such a sensitive issue.Although worrying about the unknown is naturally pointless, it's nonetheless terrifying. Everytime my concentration drifts & I start considering unseen particles of blood, the increased risk of transmission from not being circumcised and all the other variables that 'could' be relevent, I make every effort to find a distraction & calm myself down. But I do find comfort in your assessment of my situation & fully understand only time will provide definite answers.
I've been suffering with other health issues during the last couple of years and without trying to exonerate my responsibility to this situation, those problems caused deep rooted depression which acted as a catalyst for my debauched behaviour. But you live and learn & I'll certainly, regardless of outcome, be a wiser person for this experience.
As for now, I'll continue to preoccupy myself with studies & boxing, which has been an integral part of my life for many years. If you have no reservations, maybe I can occasionally update you on my journey.
Thanks for everything & may you all have a lovely Xmas.
Gary